A 78 year-old diabetic man with a colicky pain at RUQ and nausea in night. Coughing for one month he has been managed antibiotics in time.
Ultrasound detected a #94x39 mm dilated gallbladder with an impacted biliary stone at the neck of GB and some 8-13 mm other stones in the inflammed GB (# 6mm thickening of the GB wall, anterior wall partial hypoechoic). It existed an amount of fluid around the inflammed gallbladder.
MSCT confirmed an impacted #14 mm GB stone at the neck of the GB.
Emergency endoscopic surgery was done after 8 hours entering the surgical ICU to remove the inflammed GB and peritoneal pseudomembranes.
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